Artificial Neural Network Analysis Examining Substance Use Problems Co-Occurring with Anxiety and Depressive Disorders Among Adults Receiving Mental Health Treatment.

Objective: The co-occurrence of anxiety disorders, depressive disorders, and substance use problems was examined. Methods: The Mental Health Client-Level Data dataset was used to conduct logistic regression models and an artificial neural network analysis. Logistic regression analyses were conducted among adults with anxiety (n = 547,473) or depressive disorders (n = 1,610,601) as their primary diagnosis who received treatment in a community mental health center. The artificial neural network analysis was conducted with the entire sample (N = 2,158,074). Results: Approximately 30% of the sample had co-occurring high-risk substance use or substance use disorder. Characteristics including region of treatment receipt, age, education, gender, race and ethnicity, and the presence of co-occurring anxiety and depressive disorders were associated with the co-occurring high-risk substance use or a substance use disorder. Conclusions: Findings from this study highlight the importance of mental health facilities to screen for and provide integrated treatment for co-occurring disorders.

Foster Care Involvement Among Youth With Intellectual and Developmental Disabilities.

Importance: Youth with intellectual and developmental disabilities (I/DD) are more likely to be placed in foster care than other youth. Examining the clinical and sociodemographic characteristics of youth with I/DD in the foster care system is critical for identifying disparities and understanding service needs. Objective: To produce a population-level analysis of youth with I/DD in foster care that examines differences in rates of foster care involvement based on race, ethnicity, age, and sex. Design, Setting, and Participants: This cross-sectional study involved all individuals with I/DD 21 years and younger enrolled in Medicaid through foster care in 2016 via data from Transformed Medicaid Statistical Information System (T-MSIS) Analytic Files (TAF) for all 50 US states and Washington, DC. As a key insurer of I/DD services and foster care, Medicaid claims offer a timely population-level analysis. Youth with I/DD were grouped into diagnostic subgroups: autism spectrum disorder (ASD) only, intellectual disability only, or ASD and ID. The data analysis took place from July 2022 to September 2023. Exposure: TAF data contain Medicaid enrollment information by month with a binary indicator of foster care involvement, and eligibility files identify race, ethnicity, age, and sex. Main Outcomes and Measures: The period prevalence of foster care involvement was determined among I/DD youth by diagnostic subgroups using an intersectional approach across race, ethnicity, age, and sex. Logistic regression examined associations between risk for foster care involvement and race, ethnicity, age, and sex. Results: A total of 39 143 youth with I/DD had foster care involvement in 2016. Black youth (adjusted odds ratio [aOR], 1.37; 95% CI, 1.28-1.47) and females (aOR, 1.18; 95% CI, 1.1-1.27) had increased likelihood for foster care involvement. The likelihood for foster care involvement increased with age in all groups relative to the age group 0 to 5 years old. Conclusions and Relevance: This study found that among youth with I/DD, Black youth and females faced higher risk for foster care involvement, and the likelihood of foster care involvement increased with age. There is an urgent need for research that focuses on addressing system-level factors that drive increased risk. Understanding the specific health needs of Black and female youth with I/DD is critical to ensure the formation, implementation, and monitoring of equitable delivery of health services.

Assessing the Potential Efficacy of an Intervention for Incarcerated People With Mental Illness.

OBJECTIVE: This preliminary study tested the efficacy of an evidence-based correctional intervention (Thinking for a Change) with an adapted delivery to incarcerated people with mental illness. METHODS: A small-scale randomized controlled trial (N=47 men) was conducted. Outcomes were changes in aggression, number of behavioral infractions, and days in administrative segregation. Treatment targets were impulsivity, interpersonal problem-solving skills, and attitudes supportive of crime. Linear mixed-effects models were used to examine within-person and between-group differences over time, and nonparametric tests were used to examine between-group differences in criminal legal outcomes postintervention. RESULTS: Statistically significant within-person differences were found for all treatment targets and for one study outcome (aggression). Statistically significant differences in impulsivity were found between the experimental and control groups (B=-7.10, p=0.02). CONCLUSIONS: Existing evidence-based correctional interventions can affect the lives of people with mental illness. Accelerated research in this area may benefit people with mental illness at high risk for criminal legal system involvement.

Patterns in Medicaid Coverage and Service Utilization Among People with Serious Mental Illnesses.

Disruptions in Medicaid adversely affect service use and outcomes among individuals with serious mental illnesses (SMI). A retrospective longitudinal study examined Medicaid coverage and service utilization patterns among individuals with SMI (N = 8358) from 2007 to 2010. Only 36% of participants were continuously enrolled in Medicaid and 20% experienced multiple enrollment disruptions. Mental health diagnosis did not predict continuous coverage; however, individuals with schizophrenia were 19% more likely to have multiple coverage disruptions than those with depression (b = - 0.21; p < 0.01). Single and multiple coverage disruptions were associated with decreased rates of outpatient service days utilized (IRR = 0.77 and 0.65, respectively, p < 0.001) and decreased odds of not using acute care services (OR  0.26 and 0.19, respectively, p < 0.001). Future research should explore mechanisms underlying Medicaid stability and develop interventions that facilitate insurance stability and service utilization.

A Systematic Review of Interventions Targeting Criminogenic Risk Factors Among Persons With Serious Mental Illness.

OBJECTIVE: Individuals with serious mental illness are overrepresented in the criminal justice system. Research has found that interventions targeting risk factors for recidivism (i.e., criminogenic risks) reduce justice involvement in the general correctional population. However, more needs to be learned regarding use of these interventions among individuals with serious mental illness. To this end, this systematic review synthesized research on interventions that target criminogenic risk factors and are delivered to justice-involved individuals with serious mental illness. METHODS: A systematic search of six computerized bibliographic databases from inception to 2021 yielded 8,360 potentially relevant studies. Title and abstract screening, full-text reviews, and data extraction were performed independently, and discrepancies were resolved through discussion. To identify additional articles meeting inclusion criteria, experts in the field were contacted, and reference-harvesting techniques were used. Study quality was assessed with the Mixed Methods Appraisal Tool. RESULTS: Twenty-one studies were identified that evaluated nine interventions delivered to justice-involved individuals with serious mental illness. All identified programs targeted criminogenic risk factors, were group based, and used cognitive-behavioral strategies. Study quality was moderate to high. Interventions were associated with improvements in recidivism, violence, and criminogenic risk factors. CONCLUSIONS: This review is the first to evaluate interventions targeting criminogenic risks among justice-involved individuals with serious mental illness. Findings suggest that outcomes associated with these interventions are promising. Given the overrepresentation of persons with serious mental illness in the criminal justice system, these findings provide an important step toward identifying services that curb justice involvement in this population.

Preventing and improving interactions between autistic individuals and the criminal justice system: A roadmap for research.

Researchers have identified that autistic individuals are encountering the criminal justice system as victims, offenders, and witnesses at high rates. The prevalence of autism spectrum disorder (ASD) is increasing and generating a comprehensive approach to addressing criminal justice system involvement among autistic individuals is a timely and urgent need. Revisions to an established framework generated for use among individuals with mental health diagnoses, the sequential Intercept Model (SIM), were produced by an international consortium of interdisciplinary stakeholders presenting a new opportunity to identify gaps in ASD research and generate preventive solutions across the criminal justice system. The revised SIM maps each criminal justice system component, or Intercept, and includes paths for the experiences of autistic individuals as victims or witnesses to crimes as well as offenders to catalyze new and interdisciplinary research, policy, and practice efforts. As the field of ASD research continues to grow, the revised SIM is a promising pathway to avoiding siloed research approaches, including diverse autistic voices, and contributing to international dialogue about criminal justice reform at a critical juncture. LAY SUMMARY: Autistic individuals are encountering the criminal justice system as victims, offenders, and witnesses at high rates. A revised version of the SIM generated by an international consortium provides a cohesive framework to ensure research focused on this topic extends across the criminal justice system. Preventing and improving interactions between autistic individuals and the criminal justice system is an urgent research, policy, and practice need.

Accountability in Intervention Research: Developing a Fidelity Checklist of a Mental Health Intervention in Prisons.

Adherence to intervention content and delivery protocols is vital in establishing the efficacy of treatment programs for mental illnesses. Using a fidelity tool during interventions can substantially increase the likelihood of clients receiving the most scientifically rigorous treatment. This article outlines the steps taken to develop a fidelity checklist to measure treatment adherence of a two-part intervention delivered in a prison setting. Researchers followed the five-step guide by Feely et al. (Child and Adolescent Social Work Journal, 35(2), 139-152: 2018) and describe the process of developing a fidelity tool to measure treatment adherence to a newly adapted CBT-based intervention designed to maximize uptake for participants with serious mental illnesses. Key decision points are discussed, along with final decisions and contextual considerations. A 26-item checklist was developed to measure treatment adherence related to process, content, and adaptations of the intervention. The checklist follows the structure of the CBT intervention, as well as provides flexibility for the delivery adaptations. Pilot testing of the checklist revealed all sessions were implemented with at least 85% fidelity, and 90% of sessions were implemented with at least 90% fidelity. Raters agreed on the fidelity of a session in 99.6% of sessions. Contextual considerations included the highly secure study setting, reconciling the constant monitoring of a group and creating a treatment environment, the flexibility mandated by the intervention, the relative newness of the intervention, and the limitations based on study aims and resources. These results illustrate how study specific considerations and challenges can be successfully navigated in the development and deployment of a fidelity tool in a real-world setting. The fidelity checklist achieved our goal of measuring treatment adherence for this intervention. In the development of a fidelity tool, we recommend leaving space for raters to note specific considerations that disrupt facilitators' ability to deploy the intervention precisely. Measuring fidelity is imperative for mental health interventions to ensure that the treatment is responsible for the changes observed in clients.

Variation in Criminogenic Risks by Mental Health Symptom Severity: Implications for Mental Health Services and Research.

Although a growing body of literature has demonstrated that justice-involved people with mental illnesses have criminogenic risk factors at similar or elevated rates as compared to justice-involved people without mental illnesses, more information about how criminogenic risks vary by intensity of mental health symptoms is needed. This information is particularly important for probation agencies who supervise the vast majority of justice-involved individuals with mental illnesses and who are increasingly implementing specialty mental health supervision approaches. To this end, this study examines the relationship between criminogenic risk and intensity of self-reported symptoms of mental illnesses among 201,905 individuals on probation from a large southeastern state. Self-report measures of symptoms of mental illnesses were categorized as low, moderate or high and criminogenic risks were compared among the following three groups: (1) those with no or low self-reported symptoms of mental illness; (2) those reporting moderate levels of symptoms; and (3) those reporting high or elevated levels of symptoms. Our findings suggest that the strength of relationships between symptoms of mental illnesses and criminogenic risks varies by type of criminogenic risk. Also, elevated symptoms of mental illness are associated with higher levels of criminogenic risks. More research about interventions that address mental illnesses and criminogenic risks is needed to inform practice and policy.

Examining Criminogenic Risk Levels Among People with Mental Illness Incarcerated in US Jails and Prisons.

This study examines criminogenic risk levels of individuals with serious mental illness (SMI) involved in the justice system compared to justice-involved individuals without mental illness. The sample (N = 436) consisted of ninety-three individuals with SMI incarcerated in a county jail in a mid-size Midwest city, 217 individuals with SMI incarcerated in a state prison in the US Northeast, and 126 individuals without mental illness incarcerated in a state prison in the US Southwest. Results indicated that people with SMI incarcerated in jail and prison had higher overall criminal risk levels than prison inmates without mental illness. Results further demonstrated that, on average, higher percentages of persons with SMI had high/very high criminogenic risk scores. Finally, we noted that persons with SMI scored higher on most of the eight criminogenic risk domains measured by the Level of Service Inventory. These findings are possibly the most compelling to date in the growing body of literature demonstrating that justice-involved people with SMI have elevated criminogenic risk comparable to or greater than their non-mentally ill peers involved in the justice system. Consequently, treatment programs and interventions for justice-involved individuals with SMI need to explicitly target criminogenic needs into treatment efforts.

Meeting the Needs of Justice-Involved People With Serious Mental Illness Within Community Behavioral Health Systems.

The overrepresentation of people with serious mental illness in the criminal justice system is a complex problem. A long-standing explanation for this phenomenon, the criminalization hypothesis, posits that policy changes that shifted the care of people with serious mental illness from psychiatric hospitals to an underfunded community treatment setting resulted in their overrepresentation within the criminal justice system. This framework has driven the development of interventions to connect people with serious mental illness to needed mental health and substance use treatment, a critical component for people in need. However, the criminalization hypothesis is a limited explanation of the overrepresentation of people with serious mental illness in the criminal justice system because it downplays the social and economic forces that have contributed to justice system involvement in general and minimizes the complex clinical, criminogenic, substance use, and social services needs of people with serious mental illness. A new approach is needed that focuses on addressing the multiple factors that contribute to justice involvement for this population. Although the authors' proposed approach may be viewed as aspirational, they suggest that an integrated community-based behavioral health system-i.e., intercept 0-serve as the focal point for coordinating and integrating services for justice-involved people with serious mental illness.

Using the Consolidated Framework for Implementation Research to examine implementation determinants of specialty mental health probation.

BACKGROUND: Specialty mental health probation (SMHP) is designed to improve outcomes for the large number of people with serious mental illnesses who are on probation and/or parole. The evidence for specialty mental health probation is promising; however, little is known about the implementation challenges and facilitators associated with SMHP. To address this gap, we used the consolidated framework for implementation research (CFIR) to analyze 26 interviews with stakeholders representing multiple agencies involved in the implementation of SMHP. RESULTS: Results indicate a number of challenges and facilitators related to the inner setting, outer setting, implementation process, and characteristics of individuals. CONCLUSIONS: Findings suggest that complex and cross-sectoral interventions are context-dependent and introduce a number of challenges and facilitators related to multiple CFIR domains. Consequently, agency administrators implementing these types of interventions should consider small pilot studies and develop implementation strategies tailored to the local implementation context.

Conceptualizing restorative justice for people with mental illnesses leaving prison or jail.

Individuals with psychiatric disabilities who are involved in the criminal justice system face a number of challenges to community integration upon release. There is a critical need to develop and evaluate interventions for these individuals that connect them to the community by enhancing naturalistic social connections and helping them to participate meaningfully in valued roles. The purposes of this article are to describe, provide a theoretical rationale, and propose a conceptual model for the use of a particular restorative justice model, circles of support and accountability, to meet this need. We describe the principles of restorative justice (repairing harm, stakeholder involvement, and the transformation of community and governmental roles and relationships) and how these map on to elements of the circles intervention. These elements include a focus on community participation, positive social support, democratic decision making, collective ownership of crime problems, and connection to community-based resources. We then suggest how changes in identity transformation, moral development and motivation, and collective efficacy might mediate relationships between these intervention elements and community integration outcomes. Finally, we encourage the systematic evaluation of the circles intervention for people with mental health conditions leaving custody and provide recommendations for policy and practice. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Intimate Partner Violence and Women with Severe Mental Illnesses: Needs and Challenges from the Perspectives of Behavioral Health and Domestic Violence Service Providers.

Women with severe mental illnesses face high rates of violence victimization, yet little is understood about the unique needs and challenges these women present to the domestic violence and behavioral health agencies that serve them. To help address this knowledge gap, focus groups were conducted with 28 staff members from local behavioral health and domestic violence service agencies. Results from this exploratory study suggest that women with severe mental illnesses who experience intimate partner violence face additional challenges that exacerbate behavioral health and domestic violence issues and put these women at greater risk for continued victimization. DV and behavioral health agency staff experience individual-, provider-, and system-level barriers to serving this high-risk, high-need population. Recommendations and implications for domestic violence and behavioral health providers are discussed.

Interventions That Target Criminogenic Needs for Justice-Involved Persons With Serious Mental Illnesses: A Targeted Service Delivery Approach.

This research describes the development of a targeted service delivery approach that tailors the delivery of interventions that target criminogenic needs to the specific learning and treatment needs of justice-involved people with serious mental illnesses (SMI). This targeted service delivery approach includes five service delivery strategies: repetition and summarizing, amplification, coaching, low-demand practice, and maximizing participation. Examples of how to apply each strategy in session are provided, as well as recommendations on when to use each strategy during the delivery of interventions that target criminogenic needs. This targeted service delivery approach makes an important contribution to the development of interventions for justice-involved people with SMI by increasing the chances that people with SMI can participate fully in and benefit from these interventions that target criminogenic needs. These developments come at a critical time in the field as the next generation of services for justice-involved people with SMI are being developed.

Interventions That Target Criminogenic Needs for Justice-Involved Persons With Serious Mental Illnesses: A Targeted Service Delivery Approach.

This research describes the development of a targeted service delivery approach that tailors the delivery of interventions that target criminogenic needs to the specific learning and treatment needs of justice-involved people with serious mental illnesses (SMIs). This targeted service delivery approach includes five service delivery strategies: repetition and summarizing, amplification, active coaching, low-demand practice, and maximizing participation. Examples of how to apply each strategy in session are provided, as well as recommendations on when to use each strategy during the delivery of interventions that target criminogenic needs. This targeted service delivery approach makes an important contribution to the development of interventions for justice-involved people with SMI by increasing the chances that people with SMI can participate fully in and benefit from these interventions that target criminogenic needs. These developments come at a critical time in the field as the next generation of services for justice-involved people with SMI are being developed.

How Police Officers Assess for Mental Illnesses.

This study examined how police officers assess for mental illnesses and how those assessments vary by location. Researchers conducted semi-structured interviews with 15 officers working in two police districts in one city. Findings from the study indicate that officers make assessments based on information from dispatch, collateral contacts and behavioral observations on the scene. The study also found that neighborhood context shaped the assessment process due to variations in types of information that were available to officers in different locations. The findings indicate that there is a need to improve the quality of all three sources of information.

Statewide mental health training for probation officers: improving knowledge and decreasing stigma.

BACKGROUND: The large and growing number of probationers with mental illnesses pose significant challenges to the probationer officers who supervise them. Stigma towards mental illnesses among probation officers is largely unstudied and the effectiveness of training initiatives designed to educate probation officers about mental illness is unknown. To address these gaps in the literature, we report findings from a statewide mental health training initiative designed to improve probation officers' knowledge of mental illnesses. A single-group pretest posttest design was used and data about stigma towards mental illnesses and knowledge of mental illnesses were collected from 316 probation officers. Data were collected prior to and shortly after officers viewed a series of educational training modules about mental illnesses. RESULTS: Officers' knowledge of mental illnesses increased and officers demonstrated lower levels of stigma towards persons with mental illnesses as evidenced by scores on a standardized scale. CONCLUSION: Mental health education can help decrease stigma and increase knowledge of mental illnesses among probation officers. More research is needed to assess the impact of these trainings on probationers' mental health and criminal justice outcomes.